Vaginal Dryness

Vaginal dryness is a common complaint in women, especially after menopause. It is more common among women in the age group of 51-60 years in post-menopausal stage, although it can occur in any age group.

Under normal conditions, the vagina is kept moist by the lubricants produced by the glands present at the neck of the womb. The lubricant moves down to the vagina from the womb and keeps the area clean.

It also helps to remove dead cells from the vagina. The acidic content in the moisture prevents infections like thrush. Dryness of vagina is a cause of embarrassment for many women and often find it difficult to discuss the same with the physician.

Symptoms of vaginal dryness may be present at all times, or only during sex in some women.

Some of the most common problems associated with dry vagina include:

• Irritation in vagina
• Itchiness
• Burning sensation
• Discomfort and pain during sex
• Reduced sexual drive
• Difficulty in having sexual arousal
• Difficulty in reaching orgasm
• Paleness and thinning of vagina
• Narrowing of vagina
• Shortening of vagina
• Increased frequency of urination
• Recurrent urinary tract infections

Vaginal dryness may also be associated with hot flashes, mood swings, an increase in facial hair, and deep voice. It is better to get medical advice if the dryness is not resolved with self-help treatment options. It is also important to get medical attention if the dryness is severe and interferes with normal activities.

Vaginal dryness may be caused by many factors. Some of the common causes are:

• Menopause – menopause is characterized by a decrease in estrogen levels, which causes dryness in the vagina.
• Childbirth – estrogen levels may drop than normal after delivery and breastfeeding, leading to vaginal dryness.
• Insufficient arousal before sex – glands may produce insufficient lubricant if sexual arousal is less.
• Certain contraceptive pills – vaginal dryness may also occur due to combined contraceptive pills or contraceptive injection.
• Cancer treatment – radiotherapy, chemotherapy, and hormonal therapy for cancer may lead to vaginal dryness.

Certain medical conditions like diabetes and Sjögren's syndrome may affect the natural production of lubricants by the glands.

Review of symptoms is an important step in the diagnosis of vaginal dryness. Information on all associated symptoms, some of which may seem to be unrelated to vaginal dryness, may be the helpful incorrect diagnosis.

A pelvic exam is conducted during physical examination to check for possible causes. This will help to rule out other causes of dryness, like infections. Changes and abnormalities in the reproductive organs are evaluated during the pelvic exam.

Additional tests are recommended on the basis of the probable cause of dryness in the vagina. Pap smear is a common test during which sample of cells from the cervix is taken for a test for infection and cancer.

Treatment is based on the diagnosis of the cause of dryness. The most common recommendations are lubricants, vaginal moisturizers, vaginal estrogen, and hormonal replacement therapy (HRT).

Lubricants are applied to the vagina and help to keep the vagina moist. As the name indicates, vaginal moisturizers also help to keep the vagina moist. Vaginal estrogen helps to increase the levels of estrogen that is low in vaginal dryness. HRT is also a method to improve the hormonal levels that are declined during certain phases of life.

Vaginal walls are well lubricated with a layer of fluid, and this fluid is maintained by the hormone estrogen. The fluid keeps the vagina, healthy, thick, and elastic.

One of the most common causes of vaginal dryness is the drop in estrogen levels. Reduction in fluid makes the vagina thin and less elastic. Thinning of the vaginal layer is referred to as vaginal atrophy.

Some of the common causes of vaginal dryness are:

Menopause – menopause is characterized by lower-than-normal levels of estrogen, the hormone that maintains levels of lubricating fluid in the vagina. This leads to vaginal atrophy or atrophic vaginitis, a common cause of vaginal dryness. One of the first symptoms of low estrogen levels is reduced vaginal lubrication during sex. More than half of the women after menopause experience vaginal atrophy and dryness.

Childbirth – levels of estrogen drops temporarily after childbirth, leading to vaginal atrophy. This may result in vaginal dryness. If not serious, the vagina may feel drier than normal.

Breastfeeding – childbirth and breastfeeding are followed by a drop in estrogen levels, a common cause of dryness in the vagina.

Insufficient arousal before sex – not being sexually aroused, either due to insufficient foreplay or due to psychological stress, may lead to vaginal dryness.

Radiation and chemotherapy – radiation therapy, particularly of the pelvic region, and chemotherapy are two causes of vaginal dryness. Chemotherapy may affect the functioning of ovaries and reduce the production of estrogen by the gland. The hormonal changes during this treatment are abrupt and often results in sudden onset of serious symptoms.

Anti-estrogen medications – medications used to reduce estrogen in the treatment of uterine fibroids and endometriosis may result in drying out of the vaginal tissue.

Surgical removal of ovaries – surgical removal of ovaries is a cause of reduced estrogen production in premenopausal women. These women may experience menopausal symptoms, including the dry vagina.

Sjögren's syndrome -- Sjögren's syndrome is an autoimmune condition characterized by abnormal activity of the immune system that attacks the glands of the body. The glands that produce the lubricating fluid is also affected by this condition, leading to the dry vagina.

Certain medications – certain medications like those used for controlling allergy and cold, and certain antidepressants lead to vaginal dryness. These medications are known to cause dryness of mucus membranes, including vaginal mucus.

Certain hygiene products – certain hygiene products including feminine sprays, harsh soaps, and hot tub chemicals are known to cause vaginal dryness.

Frequent douching and use of certain washing powders may also cause dry vagina. Swimming pools dips are also associated with dryness in the vagina in some cases. Women who are undergoing menopausal transition may experience dryness in different intensities. The severity of symptoms also varies with women.

Review of medical history, evaluation of signs and symptoms, and physical examination are important in the diagnosis of vaginal dryness and the cause.

Information on the following may be of help in confirmatory diagnosis:

• Associated symptoms
• Severity and frequency of symptoms
• Current medications
• Any medical conditions like diabetes
• Conditions that worsen or improve dryness and itching in vagina
• Duration of symptom
• Onset of dryness

Thinning, redness, and other symptoms in the vagina are checked during a pelvic examination. This will help to rule out other conditions like urinary tract infection that lead to dryness in the region.

During a pelvic examination, the doctor may check the inner parts of the vagina to detect abnormalities in the reproductive organs, if any. A small sample of cells from the vagina is removed during Pap smear test for further analysis. This test is usually used to detect infection or cancer. There are no specific tests to evaluate the thinness and loss of elasticity of vagina.

Home treatments are the first options for relieving vaginal dryness. Over-the-counter vaginal lubricants and vaginal moisturizers may be of help in reducing the discomfort. Medical advice is needed if these self-help tips are not effective in resolving the issue. Severe and troublesome symptoms that affect normal activities also need to be reported for further diagnosis and treatment.

The main treatment for vaginal dryness are:

Lubricants – these are available in the form of gels or liquids and can be applied to the vagina to keep the area moist. Lubricants are good in providing short-term relief from dryness.

Vaginal moisturizers – moisturizers are applied inside the vagina and have a comparatively longer relieving effect than lubricants. Water-based moisturizers are better than oil- or petroleum-based moisturizers as they interfere with latex condoms, and may also irritate the vagina.

Topical estrogen therapy – it helps to replace some amount of the hormone that is produced in insufficient quantities in the body. The amount of estrogen replaced is less than that of oral HRT. Topical vaginal estrogens are three types

• Vaginal estrogen ring – this is a flexible ring is inserted into the vagina. The ring releases a stream of estrogen into the vaginal region. Once used, it is replaced every three months.
• Vaginal estrogen tablet – these tablets are inserted into the vagina using an applicator. The tablets are inserted once a day for one to two weeks. Later, it is inserted twice a week for more effect. The tablets are stopped when the issue is resolved.
• Vaginal estrogen cream – the cream is inserted into the vagina using an applicator, as in the case of the tablet. It is applied once daily for two weeks, after which the frequency is reduced to once a week.

Topical vaginal estrogen is not recommended for women who have breast cancer or have a history of endometrial cancer.

Hormone replacement therapy – HRT is the treatment method to replace estrogen levels in the body, which has reduced with menopause. HRT is used as tablets, skin implant, skin patch, or as a gel. This method is more effective than vaginal estrogen, as the applications are wider. It is usually suggested when other symptoms of menopause, like hot flashes, are also present.